Ann Thorac Surg 1997;64:158
© 1997 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Roger B. B. Mee, FRACS
The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195
See also page 154.
The Tokyo Women's Hospital group have described the fate of a relatively large series of valved equine pericardial conduits connecting the pulmonary ventricle to the pulmonary arteries. The conduit is manufactured on the operating table and was designed to redress a low availability of homografts. Early reports suggested good potential as an alternative conduit with low early incidence of calcification and leaflet dysfunction. Interestingly, this conduit has served its function well and, in terms of longevity, it has been similar to homograft and xenograft valves in a Dacron tube, corrected for size of conduit and size of patient. On the other hand, the expense of the equine pericardial conduit was much less than either of the other commercially available options. Very small homografts have probably been even less successful. Ando and associates' disappointment in their fabricated conduit at later follow-up was inevitable from the outset, but their disappointment should not be excessive.
The need or decision to insert a valved conduit continues to guarantee repeated conduit changes, particularly when the patient was small at the time of the first operation. Direct pulmonary artery-to-pulmonary ventricle anastomosis is in part a reaction to the universal disappointment in repeated attempts to find a valved conduit with better longevity. It is safe to perform a direct anastomosis in many situations, but less safe if distal pulmonary arteries are small, or in the presence of elevated pulmonary vascular resistance. It therefore appears that nongrowing, valved conduits remain a necessity and that critical to their use is to ensure that the inevitable replacements are made as safe as possible.
Related Article
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Fate of Trileaflet Equine Pericardial Extracardiac Conduit Used for the Correction of Anomalies Having Pulmonic Ventricle–Pulmonary Arterial Discontinuity
- Makoto Ando, Yasuharu Imai, Yoshinori Takanashi, Shuichi Hoshino, Kazuhiro Seo, and Masatsugu Terada
Ann. Thorac. Surg. 1997 64: 154-158.
[Abstract]
[Full Text]
